Suicidal Ideation During the Postpartum Period
Objective: To examine the association between suicidal ideation (SI), 3 weeks, 3 months, and 6 months postpartum with demographic, psychosocial, clinical factors, and depressive/anxiety symptoms (measured 24–48 hours after delivery), among a cohort of postpartum women.
Methods: This study included 1,073 mothers who gave birth in a large tertiary New York City hospital (2009–2010). Later, self-report SI was assessed using the suicide measure from the Edinburgh Postnatal Depression Scale and from the Patient Health Questionnaire.
Results: Two percent of participants presented with SI during the first 6 months postpartum. In bivariate analyses, race/ethnicity, nativity, insurance, and language were significantly correlated with SI 3 weeks, 3 months, and 6 months postpartum. Screening positive for depression (p = 0.0245) and anxiety (0.0454), assessed 1–2 days postpartum, was significantly correlated with later SI in bivariate analyses, as were antepartum complications (p = 0.001), depressive history (0.001), and self-efficacy (0.045). In adjusted models, antepartum complications (OR = 4.681, 95% CI = 1.99–10.99) and depressive history (OR-3.780, 95% CI = 1.514–9.441) were significantly associated with later postpartum SI. Heightened self-efficacy reduced the odds of later SI (p = 0.050).
Conclusion: Findings suggest that SI among a relatively healthy group of new mothers occurs with some frequency. Mothers with a history of depression and antepartum complications may be at increased risk.
- 1. Kochanek KD, Murphy SL, Xu JQ, Arias E. Mortality in the United States, 2013. NCHS Data Brief, 2013 no 178. Hyattsville, MD: National Center for Health Statistics, 2014. Available at: Accessed February2, 2015 [PubMed]
- 2. U.SDepartment of Health and Human Services (HHS) Office of the Surgeon General and National Action Alliance for Suicide Prevention. National strategy for suicide prevention: Goals and objectives for action, 2012. Washington, DC: HHS, September 2012 [PubMed]
- 3. Centers for Disease Control and Prevention. 2013. Leading causes of death, web-based injury statistics query and reporting system (WISQARS). Available at: Accessed February2, 2015[PubMed]
- 4. Crosby AE, Han B, LaVonne AGO, Parks SE, Gfroerer J. Suicidal thoughts and behaviors among adults aged ≥18 years–United States, 2008–2009. MMWR Surveill Summ 2011;60:1–22 [[PubMed]
- 5. Simon GE, Rutter CM, Peterson D, Oliver M, Whiteside U, Operskalski Do PHQ depression questionnaires completed during outpatient visits predict subsequent suicide attempt or suicide death?Psychiatric Serv 2013;64:1195–1202
- 6. Nierenberg AA, Gray SM, Grandin LD. Mood disorders and suicide. J Clin Psychiatry 2001;62:27–30 [[PubMed]
- 7. Lowe B, Spitzer RL, Williams JBW, Mussell M, Schellberg D, Kroenke K. Depression, anxiety and somatization in primary care: Syndrome overlap and functional impairment. Gen Hosp Psychiatry 2008;30:191–199 [[PubMed]
- 8. Davidson CL, Wingate LR, Grant DM, Judah MR, Mills AR. Interpersonal suicide risk and ideation: The influence of depression and social anxiety. J Soc Clin Psychol 2011;30:842–855 [PubMed]
- 9. Sareen J, Cox BJ, Afifi TO, et al. Anxiety disorders and risk for suicidal ideation and suicide attempts: A population-based longitudinal study of adults. Arch Gen Psychiatry 2005;62:1249–1257 [[PubMed][Google Scholar]
- 10. Gold LH. Postpartum disorders in primary care: Diagnosis and treatment. Primary Care 2002;29:27–41 [[PubMed]
- 11. Coates AO, Schaefer CA, Alexander JL. Detection of postpartum depression and anxiety in a large health plan. J Behav Health Serv Res 2004;31:117–133 [[PubMed]
- 12. Wenzel A, Hugen EN, Jackson LC, Brendle JR. Anxiety symptoms and disorders at eight weeks postpartum. J Anxiety Disord 2005;19:295–311 [[PubMed]
- 13. Pinheiro RT, da Silva RA, Magalhaes PVS, Horta BL, Pinheiro KAT. Two studies on suicidality in the postpartum. Acta Psychiatr Scand 2008;118:160–163 [[PubMed]
- 14. Lindahl V, Pearson JL, Colpe L. Prevalence of suicidality during pregnancy and postpartum. Arch Womens Ment Health 2005;8:77–87 [[PubMed]
- 15. Henshaw C. Maternal suicide. In: Cockburn J, Pawson ME, eds. Psychological Challenges in Obstetrics and Gynecology. London: Springer, 2007;157–164 [PubMed]
- 16. Lancaster Palladino C, Singh V, Campbell J, Flynn H, Gold KJ. Homicide and Suicide during the perinatal period: Findings from the national violent death reporting system. Obstet Gynecol 2011;118:1060–1067
- 17. Howell EA, Balbierz A, Wang J, Parides M, Zlotnick C, Leventhal H. Reducing postpartum depressive symptoms among black and Latina mothers: A randomized controlled trial. Obstet Gynecol 2012;119:942–949
- 18. Howell EA, Bodnar-Deren S, Balbierz A, et al. An intervention to reduce postpartum depressive symptoms: A randomized controlled trial. Arch Womens Ment Health 2014;17:57–63 [Google Scholar]
- 19. Howell EA, Bodnar-Deren S, Balbierz A, Parides M, Bickell N. An intervention to extend breastfeeding among black and Latina mothers after delivery. Am J Ob Gyn 2014;210:e1–e5
- 20. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987;150:782–786 [[PubMed]
- 21. Hanusa BH, Hudson Scholle S, Haskett RF, Spadaro K, Wisner KL. Screening for depression in the postpartum period: A comparison of three instruments. J Women's Health 2008;17:585–596
- 22. Eberhard-Gran M, Eskild A, Tambs K, Opjordsmoen S, Samuelsen SO. Review of validation studies of the Edinburgh Postnatal Depression Scale. Acta Psychiatr Scand 2001;104:243–249 [[PubMed]
- 23. Murray L, Carothers AD. The validation of the Edinburgh Postnatal Depression Scale on a community sample. Br J Psychiatry 1990;27:472–476 [[PubMed]
- 24. Gaynes BN, Meltzer-Brody S, Lohr KN, et al. Perinatal depression: Prevalence, screening accuracy, and screening outcomes. AHRQ Publication 2005; No. 05-E006-2, Rockville. MD
- 25. Jossefsson A, Angelsioo L, Berg G, et al. Obstetric, somatic, and demographic risk factors for postpartum depressive symptoms. Obstet Gynecol 2002;99:223–228 [[PubMed][Google Scholar]
- 26. Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder. Arch Intern Med 2006;166:1092–1097 [[PubMed]
- 27. Clark LA, Watson D, Mineka S. Temperament, personality, and the mood and anxiety disorders. J Abnorm Psychol 1994;103:103–116 [[PubMed]
- 28. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 2002;52:69–77 [[PubMed]
- 29. Coelho HF, Murray L, Royal-Lawson M, Cooper PJ. Antenatal anxiety disorder as a predictor of postnatal depression: A longitudinal study. J Affect Disord 2011;129:348–353 [[PubMed]
- 30. Howell EA, Mora PA, Horowitz CR, Leventhal H. Racial and ethnic differences in factors associated with early postpartum depressive symptoms. Obstet Gynecol 2005;105:1442–1450
- 31. Howell EA, Mora PA, DiBonaventura MD, Leventhal H. Modifiable factors associated with changes in postpartum depressive symptoms. Arch Womens Ment Health 2009;12:113–120 [[PubMed]
- 32. Howard L, Flach C, Mehay A, Sharp D, Tylee A. The prevalence of suicidal ideation identified by the Edinburgh Postnatal Depression Scale in postpartum women in primary care: Findings from the RESPOND trial. BMC Pregnancy Childbirth 2011;11:57.
- 33. Meltzer-Brody S. New Insights into perinatal depression: Pathogenesis and treatment during pregnancy and postpartum. Dialogues Clin Neurosci 2011;13:89–100
- 34. Paris R, Bolton RE, Weinberg MK. Postpartum depression, suicidality, and mother-infant interactions. Arch Women's Ment Health 2009;12:309–321 [[PubMed]
- 35. Balbierz A, Bodnar-Deren S, Wang J, Howell EA. Maternal depressive symptoms and parenting practices 3-months postpartum. Matern Child Health J 2014;19:1212–1219